Project Summary/Abstract Liver cancer, primarily hepatocellular carcinoma (HCC), accounts for ~662,000 deaths each year and is the third leading cause of death from cancer worldwide. The age-adjusted incidence of HCC tripled between 1975 and 2005 in the US, and primary liver cancer mortality rates have increased faster than mortality for any other tumor type. One- and 3-year survival rates were 36% and 17%, respectively, in the Surveillance, Epidemiology and End Results (SEER) registries from 1998 to 2000. HCC is treated by aggressive surgery, liver transplantation, radiation, chemoembolization or chemotherapy. Only one drug (Nexavar/sorafenib) is approved for HCC and this extends life by a modest 4 months. The introduction of new and efficacious therapeutic options is critical for effective management of this disease, particularly in cases where tumor has spread to secondary sites. NovaTarg has established a novel approach to HCC treatment in which biguanides are designed to utilize transporters (OCT1 and OCT3) expressed on hepatocytes. These biguanides are selectively taken up by HCC cells where they activate AMPK and regulate cell growth and energy utilization. It is well established that the LKB1-AMPK pathway plays an important role in tumor suppression; inhibiting both cell proliferation and protein synthesis by regulating the actions of p53, mTOR, p27 and cyclin D1. Metformin, a biguanide known to activate AMPK, has been shown to prevent development of HCC in diabetes patients and to display antitumor activity in vitro and in vivo in tumor models. Importantly, metformin is synergistic with chemotherapy, radiation therapy and is active against cancer stem cells. NovaTarg is improving biguanide potency and targeting them to liver cells for the treatment of HCC. NovaTarg biguanides are derivatives of metformin which are more potent, transporter specific and focused on liver cancer cells. For example an early lead compound, NT1014, potently activates AMPK in liver (OCT1) cells, is ~12x more potent at inhibiting growth of Huh7 cells as compared with metformin and is a promising lead compound that NovaTarg is will optimize to create a drug candidate in this Phase 1 project. Using detailed SAR analysis to inform the design of next generation compounds we will, over a 12 month period, prepare new molecules that both deliver the desired pharmacological profile to HCC cells, as well as building in the physicochemical properties required in a drug molecule. Compounds that meet our selection criteria will be subjected to pharmacokinetic analysis and in vivo evaluation in mouse xenograft models of HCC in order to identify a drug candidate that we will be progressed to drug development in a Phase 2 application. It is worth noting that biguanides, such as metformin, fall into a known drug class which has demonstrated good drug molecule properties and safety in human subjects.